Mr. Bernard Gloster:

Good morning. I thank the committee for the invitation to attend this meeting to discuss a range of aspects regarding the HSE provision of services to people with disabilities. I am joined by my colleagues, as the Chair has outlined, and I am supported by Ms Sara Maxwell, general manager in my office.

I will start by focusing on the resource profile of the HSE disability services. Funding of disability services within and through the HSE has increased in recent years. The 2025 allocation for disabilities is €3.2 billion, which is an increase of €330 million on the 2024 allocation. The increased funding is made up of €131 million, or 40%, to meet both the pay costs from the public sector agreement and the WRC agreement in respect of section 39 workers in the disability sector. A total of €199 million is to fund the incremental cost of 2024 activity, of which €111 million mainly relates to residential placements and day services. There are also additions for demographic pressures and some new developments.

Regarding the staffing of disability services, in December 2019, 18,244 whole-time equivalents were employed in these services, that is, services of the HSE and section 38, not section 39, agencies. In April 2025, this number had grown to 21,761. We are currently engaged with the Minister, the Ministers of State and the Department with the aim of bringing full clarity to the resource position going forward. This will allow for better planning and appropriate control of expenditure.

We hope to conclude a necessary pay and numbers strategy for this sector in 2025. I consider this a significant priority. I welcome the commitment in the programme for Government to the possibility of multi-annual funding approaches, as this would bring certainty to both the pay and non-pay aspects.

Outside of pay, the significant costs in disability services are the provision of residential care placements and grants to section 38 and section 39 agencies. Given the increased volume and complexity of demand in respect of disability services, it is essential the HSE be able to plan beyond a single year.

In the context of our services, we will provide residential care to almost 8,700 people and intensive support packages to a further 600 in 2025. Day services of various types will be provided to 23,000 people. Some 6,300 people will avail of respite supports, while 10,000 people will avail of either personal assistance or home support hours, totalling 5.5 million hours.

Despite these record levels of resourcing and services, many challenges remain for people, both for children and adults and their families who care for them. From a HSE perspective, these challenges can be prioritised and are quite similar to other challenges in health service provision, such as: access to services; recruitment and retention of specialist staff; and models of care being relevant to the individual need or experience of people. The HSE is working with the Department of Children, Disability and Equality and across the Government through the dedicated Cabinet committee on disability to respond to these challenges. A HSE response alone is not an effective solution to any of these challenges. Our most significant challenge is not the absence of plans, but the pace at which we can implement them and bring about necessary change.

I particularly wish to reference children’s specialist disability services. I am acutely aware of the serious challenges in that part of our work. While members will be familiar with the issues associated with assessment of need, I wish to emphasise that exclusive focus on that would be somewhat misplaced. Assessment is important and has its place. It requires reform. In my experience, however, what people want most is access to services and supports. I have recently met several groups of parents in different regions and separately with staff working in disability services to hear both their experiences and practical solutions as to how we approach change. I hope in the coming months to add to our approach by taking some practical steps, which are informed and will yield improvement. These steps include: a single point of entry for referral of children to community healthcare services, inclusive of primary care, disability and CAMHS; a dedicated key work co-ordinator post in each area; a reduction in therapists' time in non-therapy administrative work; and a more flexible approach to how we implement the progressing disability services programme.

I will conclude with two remarks. First, I thank the many staff we have across the country who work in our disability services, be they in section 38 or 39 organisations.

They come to work every day to support people to live a life to their full potential. They do that with professionalism and care in equal measure.

Second, I want to recognise that despite a significant amount of services delivered, increased Government investment and a renewed focus on building our capacity, I am conscious that for many people today, we simply have come up short. It is important for me as CEO of the HSE to recognise this, apologise to those families and explain our attempts to do something about it.

In conclusion, my statement was submitted prior to the airing of last evening's report on the "Prime Time" programme in respect of people under the age of 65 living in nursing homes. I want to acknowledge the significance and seriousness of that issue. I am certainly very happy in the course of the morning to address any questions members have on that.